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Over 45,000 5010 claims a day – That’s how we lead the way to 5010

September 26, 2011

Continual change continues to be the norm in the world of healthcare. Implementing the new HIPAA X12 5010 electronic data interchange standards, mandated by the Department of Health and Human Services could require practices to upgrade or even replace their current information systems and modify their existing coding practices.

We, at Sage Healthcare, are no strangers to changes like this. It’s apparent that the more than two years spent planning, building and testing our systems for 5010 has paid off, especially for our clients. We began 5010 testing in 2010, began deploying 5010 updates for products, including Sage Intergy and Sage Medical Manager, earlier this year, and, currently are processing more than 45,000 5010 claim transactions each day.

“Sage was the first software vendor to test on the 5010 final rule and the addenda and to go into production,” said Philip Hardin, Executive Vice President, Provider Services, at Emdeon. “We get more 5010 production volume from Sage for claims, ERA and eligibility than from any other submitter.”

We continue to lead and support our clients through change; transitioning to 5010 is no different. In addition to delivering guidance to clients and providing software solutions that fully support the new 5010 transaction standards, our 5010 solutions are designed to minimize the cash flow risk of the 5010 standard change for physicians and their practices.

The 5010 transaction standard improves the electronic exchange of information between organizations, which is a vital component as the industry embraces health information exchanges (HIEs) and programs to better coordinate care delivery. To those within the physician space, the 5010 transition provides the framework to implement ICD-10, which creates a more detailed coding structure to describe diagnoses and procedures. The higher level of detail within the ICD-10 code set will help physician practices closely monitor the quality of their care delivery while participating in an increasing number of pay-for-performance programs.

Implementing 5010 offers providers several benefits that they can take advantage of following implementation of the standards, such as increased functionality within EDI transactions. It’s anticipated that an increasing number of payers will take advantage of the 5010 standard. The improved use of the transactions by payers will help providers increase efficiencies and reduce overall costs across their practice.

The January 1, 2012, 5010 deadline is rapidly approaching, so practices should not delay in upgrading their systems to become compliant. Taking the time now to upgrade to a 5010-compliant system will reduce the risk associated with backlogs and last-minute requests.

The improvements in the 5010 standard set will help provider organizations achieve larger strategic goals, such as better connecting with HIEs and monitoring the care quality measures that are vital to earn full reimbursement. The organizations that carefully implement and fully leverage 5010 will have a competitive advantage in an industry that is moving toward paying for quality care, as opposed to simply paying for care delivery.

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